Pathology

Test & Collection Guide

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PLEASE NOTE: Recent changes have been made to this Test

Recent changes for Hepatitis Serology

Date

Field

Changed From

Changed To

25th September 2024

Processing Instructions

Virus/Test	Test codes Ordered	Notes
Hepatitis A
Hepatitis A IgM	HAM	For acute Hep A
Hepatitis A total	HAV	For previous infection/vaccination
Hepatitis A PCR	HEPAR	For acute Hep A
Hepatitis B
Hepatitis B surface antigen	HBSAG	For acute infection
Hepatitis B surface antibody	HBSAB	For vaccination status
Hepatitis B core antibody	HBCORA	For previous Hep B infection
Hepatitis B core IgM	HBCORM	For acute infection
Hepatitis B “e” antigen/antibody	HEPBE	For Hep B monitoring
Hepatitis B viral load	HBVL	For Hep B monitoring
Hepatitis C
Hepatitis C antibody	HEPC	For Hep C status (acute or chronic)
Hepatitis C PCR	HEPCR	For Hep C status (acute or chronic)
Hepatitis C viral load	HEPCVL	Hep C monitoring
Hepatitis C genotype	HEPCG	Hep C monitoring
Hepatitis D
Hepatitis D antibody	HEPDAB	Hepatitis D status
Hepatitis D PCR	HEPDR	Hepatitis D status
Hepatitis E
Hepatitis E antibody	HEPEG	Hepatitis E status

Method

Virus/Test	Test codes Ordered	Notes
Hepatitis A
Hepatitis A IgM	HAM	For acute Hep A
Hepatitis A total	HAV	For previous infection/vaccination
Hepatitis A PCR	HEPAR	For acute Hep A
Hepatitis B
Hepatitis B surface antigen	HBSAG	For acute infection
Hepatitis B surface antibody	HBSAB	For vaccination status
Hepatitis B core antibody	HBCORA	For previous Hep B infection
Hepatitis B core IgM	HBCORM	For acute infection
Hepatitis B “e” antigen/antibody	HEPBE	For Hep B monitoring
Hepatitis B viral load	HBVL	For Hep B monitoring
Hepatitis C
Hepatitis C antibody	HEPC	For Hep C status (acute or chronic)
Hepatitis C PCR	HEPCR	For Hep C status (acute or chronic)
Hepatitis C viral load	HEPCVL	Hep C monitoring
Hepatitis C genotype	HEPCG	Hep C monitoring
Hepatitis D
Hepatitis D antibody	HEPDAB	Hepatitis D status
Hepatitis D PCR	HEPDR	Hepatitis D status
Hepatitis E
Hepatitis E antibody	HEPEG	Hepatitis E status

Notes

Hepatitis testing – Which test to order?

1. Principles of hepatitis testing

Consider the incubation periods:

Hepatitis A: 2 - 6 weeks

Hepatitis B: 1 - 6 months

Hepatitis C: 15 days - 5 months

Types of antibodies:

IgM is detected in recent infection and lasts for about 3 months

IgG alone occurs with past infection, carrier states and vaccination

IgM & IgG occur together in recent infection

2. The jaundiced patient - ?Acute (infectious) hepatitis

Is this Hepatitis A, B or C?

Also consider:

EBV, CMV

Non-infectious causes of jaundice (biliary obstruction, medications, alcohol)

3. Testing for acute hepatitis

HBsAg (hepatitis B surface antigen)

Occurs 2-6 weeks before onset of symptoms

If HBsAg detected, request HBcIgM (hepatitis B core IgM antibody - usually present at onset of symptoms).

HAV IgM

Occurs with onset of abnormal LFTs

HCV Ab / Anti-HCV

Present at onset of symptoms in 50 -70% patients

Occurs by 20 weeks in 95% patients

If negative early, repeat if no other cause found

4. Antenatal hepatitis screen

HBsAg - To detect maternal chronic hepatitis B infection (‘carrier’)

(HCV antibody only if requested)

5. Post Vaccination Check

Hepatitis B vaccination

Check HBsAb (Anti-HBs, hepatitis B surface antibody)

Timing: 4 weeks after 3rd vaccination

If negative, consider checking for HBsAg (hepatitis B surface antigen) carriage

Hepatitis A vaccination

Anti-HAV Total antibody

Note - There is no hepatitis C vaccination available currently

6. Blood or body fluid exposure (eg. needlestick injury / mucosal splash)

Source (eg. patient):

HBsAg, HCV Ab (Anti-HCV), HIV Ab (Anti-HIV)

Recipient (eg. healthcare worker):

HBsAb (Anti-HBs) + baseline LFTs if ‘Source’ hepatitis serology positive

Store serum for 2 years

7. Possible hepatitis B ‘carrier’ (chronic hepatitis B infection)

Check HBsAg

If HBsAg detected then check

- HBeAg and HBeAb (Anti-HBe)
- HBV DNA

8. Possible chronic hepatitis C infection

Check HCV Ab (Anti-HCV)

If detected, then check Hep C PCR

9. Tests for patients at risk of blood borne viruses

HBsAg:

If negative check HBcAb (Anti-HBc, hepatitis B core antibody) for previous infection

If detected check HBeAg, HBeAb (Anti-HBe) & HBV DNA to assess infectivity

HCV Ab (Anti-HCV): If detected, check Hep C PCR

Anti-HAV Total antibody: If at risk of hepatitis A prior to immunisation (eg injecting drug users, men who have sex with men).

10. GLOSSARY

10.1 Hepatitis A
HAV	Hepatitis A virus
HAV IgM	Hepatitis A IgM antibody; Recent infection with Hepatitis A
HAV Total Ab	Hepatitis A total antibody; Detects both IgG and IgM antibody
	- Immunity to hepatitis A: post-infection or vaccination (IgG component positive)
	- Will be positive in acute hepatitis A infection (IgM +/- IgG components positive – check HAV IgM if recent infection is suspected)
10.2 Hepatitis B
HBV	Hepatitis B virus
HBsAg	Hepatitis B surface antigen; Indicates virus present (acute infection or chronic ‘carrier’ state
HBsAb/Anti-HBs	Hepatitis B surface antibody; Immune to Hepatitis B, post-vaccination or post-infection
HBcIgM/Anti-HBcIgM	Hepatitis B core IgM; Recent hepatitis B infection
HBcAb/Anti-HBc	Hepatitis B core antibody; Past hepatitis B infection or chronic infection/’carrier’ if HBsAg + . (If recent infection suspected, request HBcIgM).
HBeAg	Hepatitis B e antigen; Relatively more infectious
HBeAb/Anti-HBe	Hepatitis B e antibody; Less infectious
HBV DNA	Hepatitis B viral DNA; Marker of infectivity, used for planning and monitoring treatment
10.3 Hepatitis C
HCV	Hepatitis C virus
HCV Ab/Anti-HCV	Hepatitis C antibody; Current or past infection with hepatitis C
Hep C PCR	Hepatitis C polymerase chain reaction; Evidence of hepatitis C RNA - current infection with hepatitis C
	There is no HCV IgM test available. Hepatitis C genotyping is only available for hepatologists planning treatment

11. Any Questions?

Call the Core Laboratory 9895 3471 and speak to the Senior Scientist.

Compiled by Dr Mary O'Reilly, Head of Eastern Health Infectious Diseases & Infection Control.

Hepatitis testing – Which test to order?

1. Principles of hepatitis testing

Consider the incubation periods:

Hepatitis A: 2 - 6 weeks

Hepatitis B: 1 - 6 months

Hepatitis C: 15 days - 5 months

Types of antibodies:

IgM is detected in recent infection and lasts for about 3 months

IgG alone occurs with past infection, carrier states and vaccination

IgM & IgG occur together in recent infection

2. The jaundiced patient - ?Acute (infectious) hepatitis

Is this Hepatitis A, B or C?

Also consider:

EBV, CMV

Non-infectious causes of jaundice (biliary obstruction, medications, alcohol)

3. Testing for acute hepatitis

HBsAg (hepatitis B surface antigen)

Occurs 2-6 weeks before onset of symptoms

If HBsAg detected, request HBcIgM (hepatitis B core IgM antibody - usually present at onset of symptoms).

HAV IgM

Occurs with onset of abnormal LFTs

HCV Ab / Anti-HCV

Present at onset of symptoms in 50 -70% patients

Occurs by 20 weeks in 95% patients

If negative early, repeat if no other cause found

4. Antenatal hepatitis screen

HBsAg - To detect maternal chronic hepatitis B infection (‘carrier’)

(HCV antibody only if requested)

5. Post Vaccination Check

Hepatitis B vaccination

Check HBsAb (Anti-HBs, hepatitis B surface antibody)

Timing: 4 weeks after 3rd vaccination

If negative, consider checking for HBsAg (hepatitis B surface antigen) carriage

Hepatitis A vaccination

Anti-HAV Total antibody

Note - There is no hepatitis C vaccination available currently

6. Blood or body fluid exposure (eg. needlestick injury / mucosal splash)

Source (eg. patient):

HBsAg, HCV Ab (Anti-HCV), HIV Ab (Anti-HIV)

Recipient (eg. healthcare worker):

HBsAb (Anti-HBs) + baseline LFTs if ‘Source’ hepatitis serology positive

Store serum for 2 years

7. Possible hepatitis B ‘carrier’ (chronic hepatitis B infection)

Check HBsAg

If HBsAg detected then check

- HBeAg and HBeAb (Anti-HBe)
- HBV DNA

8. Possible chronic hepatitis C infection

Check HCV Ab (Anti-HCV)

If detected, then check Hep C PCR

9. Tests for patients at risk of blood borne viruses

HBsAg:

If negative check HBcAb (Anti-HBc, hepatitis B core antibody) for previous infection

If detected check HBeAg, HBeAb (Anti-HBe) & HBV DNA to assess infectivity

HCV Ab (Anti-HCV): If detected, check Hep C PCR

Anti-HAV Total antibody: If at risk of hepatitis A prior to immunisation (eg injecting drug users, men who have sex with men).

10. GLOSSARY

10.1 Hepatitis A
HAV	Hepatitis A virus
HAV IgM	Hepatitis A IgM antibody; Recent infection with Hepatitis A
HAV Total Ab	Hepatitis A total antibody; Detects both IgG and IgM antibody
	- Immunity to hepatitis A: post-infection or vaccination (IgG component positive)
	- Will be positive in acute hepatitis A infection (IgM +/- IgG components positive – check HAV IgM if recent infection is suspected)
10.2 Hepatitis B
HBV	Hepatitis B virus
HBsAg	Hepatitis B surface antigen; Indicates virus present (acute infection or chronic ‘carrier’ state
HBsAb/Anti-HBs	Hepatitis B surface antibody; Immune to Hepatitis B, post-vaccination or post-infection
HBcIgM/Anti-HBcIgM	Hepatitis B core IgM; Recent hepatitis B infection
HBcAb/Anti-HBc	Hepatitis B core antibody; Past hepatitis B infection or chronic infection/’carrier’ if HBsAg + . (If recent infection suspected, request HBcIgM).
HBeAg	Hepatitis B e antigen; Relatively more infectious
HBeAb/Anti-HBe	Hepatitis B e antibody; Less infectious
HBV DNA	Hepatitis B viral DNA; Marker of infectivity, used for planning and monitoring treatment
10.3 Hepatitis C
HCV	Hepatitis C virus
HCV Ab/Anti-HCV	Hepatitis C antibody; Current or past infection with hepatitis C
Hep C PCR	Hepatitis C polymerase chain reaction; Evidence of hepatitis C RNA - current infection with hepatitis C
	There is no HCV IgM test available. Hepatitis C genotyping is only available for hepatologists planning treatment

11. Any Questions?

Call the Core Laboratory 9895 3471 and speak to the Senior Scientist.

25th September 2024

Request Group

ACHEP

see table below

Processing Instructions

Virus/Test	Test codes Ordered	Notes
Hepatitis A
Hepatitis A IgM	HAM	For acute Hep A
Hepatitis A total	HAV	For previous infection/vaccination
Hepatitis A PCR	HEPAR	For acute Hep A
Hepatitis B
Hepatitis B surface antigen	HBSAG	For acute infection
Hepatitis B surface antibody	HBSAB	For vaccination status
Hepatitis B core antibody	HBCORA	For previous Hep B infection
Hepatitis B core IgM	HBCORM	For acute infection
Hepatitis B “e” antigen/antibody	HEPBE	For Hep B monitoring
Hepatitis B viral load	HBVL	For Hep B monitoring
Hepatitis C
Hepatitis C antibody	HEPC	For Hep C status (acute or chronic)
Hepatitis C PCR	HEPCR	For Hep C status (acute or chronic)
Hepatitis C viral load	HEPCVL	Hep C monitoring
Hepatitis C genotype	HEPCG	Hep C monitoring
Hepatitis D
Hepatitis D antibody	HEPDAB	Hepatitis D status
Hepatitis D PCR	HEPDR	Hepatitis D status
Hepatitis E
Hepatitis E antibody	HEPEG	Hepatitis E status

Hepatitis Serology

Ordering information:

Please note that 'Hepatitis Serology' can cover a wide range of tests, each of which has different clinical applications. If possible, please specify the tests required, or contact the laboratory if you need clarification regarding the types of tests available.

Alternate names:

Hep A serology, Hep B e serology, Hep B serology, Hep C serology, Hepatitis A serology, Hepatitis B e serology, Hepatitis B serology, Hepatitis C serology

Laboratory:

Biochemistry

Test Code:

see table below

Specimen types:

Serum

Container types:

Serum tube with gel

Collection Instructions:

All PCR tests require a tube of their own.

Please request each specific antigen and/or antibody required. Please supply history of illness and history of contacts/vaccinations.

Notes:

Hepatitis testing – Which test to order?

1. Principles of hepatitis testing

Consider the incubation periods:

Hepatitis A: 2 - 6 weeks

Hepatitis B: 1 - 6 months

Hepatitis C: 15 days - 5 months

Types of antibodies:

IgM is detected in recent infection and lasts for about 3 months

IgG alone occurs with past infection, carrier states and vaccination

IgM & IgG occur together in recent infection

2. The jaundiced patient - ?Acute (infectious) hepatitis

Is this Hepatitis A, B or C?

Also consider:

EBV, CMV

Non-infectious causes of jaundice (biliary obstruction, medications, alcohol)

3. Testing for acute hepatitis

HBsAg (hepatitis B surface antigen)

Occurs 2-6 weeks before onset of symptoms

If HBsAg detected, request HBcIgM (hepatitis B core IgM antibody - usually present at onset of symptoms).

HAV IgM

Occurs with onset of abnormal LFTs

HCV Ab / Anti-HCV

Present at onset of symptoms in 50 -70% patients

Occurs by 20 weeks in 95% patients

If negative early, repeat if no other cause found

4. Antenatal hepatitis screen

HBsAg - To detect maternal chronic hepatitis B infection (‘carrier’)

(HCV antibody only if requested)

5. Post Vaccination Check

Hepatitis B vaccination

Check HBsAb (Anti-HBs, hepatitis B surface antibody)

Timing: 4 weeks after 3rd vaccination

If negative, consider checking for HBsAg (hepatitis B surface antigen) carriage

Hepatitis A vaccination

Anti-HAV Total antibody

Note - There is no hepatitis C vaccination available currently

6. Blood or body fluid exposure (eg. needlestick injury / mucosal splash)

Source (eg. patient):

HBsAg, HCV Ab (Anti-HCV), HIV Ab (Anti-HIV)

Recipient (eg. healthcare worker):

HBsAb (Anti-HBs) + baseline LFTs if ‘Source’ hepatitis serology positive

Store serum for 2 years

7. Possible hepatitis B ‘carrier’ (chronic hepatitis B infection)

Check HBsAg

If HBsAg detected then check

- HBeAg and HBeAb (Anti-HBe)
- HBV DNA

8. Possible chronic hepatitis C infection

Check HCV Ab (Anti-HCV)

If detected, then check Hep C PCR

9. Tests for patients at risk of blood borne viruses

HBsAg:

If negative check HBcAb (Anti-HBc, hepatitis B core antibody) for previous infection

If detected check HBeAg, HBeAb (Anti-HBe) & HBV DNA to assess infectivity

HCV Ab (Anti-HCV): If detected, check Hep C PCR

Anti-HAV Total antibody: If at risk of hepatitis A prior to immunisation (eg injecting drug users, men who have sex with men).

10. GLOSSARY

10.1 Hepatitis A
HAV	Hepatitis A virus
HAV IgM	Hepatitis A IgM antibody; Recent infection with Hepatitis A
HAV Total Ab	Hepatitis A total antibody; Detects both IgG and IgM antibody
	- Immunity to hepatitis A: post-infection or vaccination (IgG component positive)
	- Will be positive in acute hepatitis A infection (IgM +/- IgG components positive – check HAV IgM if recent infection is suspected)
10.2 Hepatitis B
HBV	Hepatitis B virus
HBsAg	Hepatitis B surface antigen; Indicates virus present (acute infection or chronic ‘carrier’ state
HBsAb/Anti-HBs	Hepatitis B surface antibody; Immune to Hepatitis B, post-vaccination or post-infection
HBcIgM/Anti-HBcIgM	Hepatitis B core IgM; Recent hepatitis B infection
HBcAb/Anti-HBc	Hepatitis B core antibody; Past hepatitis B infection or chronic infection/’carrier’ if HBsAg + . (If recent infection suspected, request HBcIgM).
HBeAg	Hepatitis B e antigen; Relatively more infectious
HBeAb/Anti-HBe	Hepatitis B e antibody; Less infectious
HBV DNA	Hepatitis B viral DNA; Marker of infectivity, used for planning and monitoring treatment
10.3 Hepatitis C
HCV	Hepatitis C virus
HCV Ab/Anti-HCV	Hepatitis C antibody; Current or past infection with hepatitis C
Hep C PCR	Hepatitis C polymerase chain reaction; Evidence of hepatitis C RNA - current infection with hepatitis C
	There is no HCV IgM test available. Hepatitis C genotyping is only available for hepatologists planning treatment

11. Any Questions?

Call the Core Laboratory 9895 3471 and speak to the Senior Scientist.

Frequency:

Daily

Result Turnaround Time:

5 hours

Laboratory Use Only

Laboratory Notes:

Virus/Test	Test codes Ordered	Notes
Hepatitis A
Hepatitis A IgM	HAM	For acute Hep A
Hepatitis A total	HAV	For previous infection/vaccination
Hepatitis A PCR	HEPAR	For acute Hep A
Hepatitis B
Hepatitis B surface antigen	HBSAG	For acute infection
Hepatitis B surface antibody	HBSAB	For vaccination status
Hepatitis B core antibody	HBCORA	For previous Hep B infection
Hepatitis B core IgM	HBCORM	For acute infection
Hepatitis B “e” antigen/antibody	HEPBE	For Hep B monitoring
Hepatitis B viral load	HBVL	For Hep B monitoring
Hepatitis C
Hepatitis C antibody	HEPC	For Hep C status (acute or chronic)
Hepatitis C PCR	HEPCR	For Hep C status (acute or chronic)
Hepatitis C viral load	HEPCVL	Hep C monitoring
Hepatitis C genotype	HEPCG	Hep C monitoring
Hepatitis D
Hepatitis D antibody	HEPDAB	Hepatitis D status
Hepatitis D PCR	HEPDR	Hepatitis D status
Hepatitis E
Hepatitis E antibody	HEPEG	Hepatitis E status

Test & Collection Guide

PLEASE NOTE: Recent changes have been made to this Test

Recent changes for Hepatitis Serology

Date

Field

Changed From

Changed To

Processing Instructions

Method

Notes

Request Group

Processing Instructions

Hepatitis Serology

Ordering information:

Alternate names:

Laboratory:

Test Code:

Specimen types:

Container types:

Collection Instructions:

Notes:

Frequency:

Result Turnaround Time:

Laboratory Use Only

Laboratory Notes:

Pathology Handbook

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